[By Debbie Maimon]
For the second time in a month, evidence has surfaced about a case of neonatal herpes that shatters a myth about metzitzah b’peh (mbp) that the New York City Department of Health (DOH) is bent on propagating.
The DOH wants to prohibit mohelim from performing the practice during circumcision, claiming it can lead to death or brain damage in newborns by spreading herpes infection (HSV-1). No direct evidence in the medical literature supports this allegation. In addition, it flies in the face of clear evidence of an impressive record of safety over thousands of years of practice.
Nonetheless, the DOH has irrationally embraced the notion that mbp is life-threatening to infants almost as an article of faith.
A recent DOH report ascribes a 2011 case of neonatal death and an earlier 2005 case of neonatal brain damage to a herpes infection which it says was caused by metzitzah b’peh. The two cases are used to spread fear that the practice is dangerous to newborns and to rally public support for a DOH proposal aimed at severely limiting mbp.
In a live interview with Yated earlier this month, however, the mother of the baby who died came forward to set the record straight. Mrs. K. testified that her newborn’s older sibling who had recurrent oral herpes–a fact recorded in hospital records—and had shared his pacifier with the infant, had been the likely source of the infection.
This week, Mr. R.*, the father of the baby in a second case cited by the DOH, in which a herpes infection in an infant led to brain damage, stepped forward with startling disclosures.
In an interview with Yated, Mr. R. exposed the fallacy of the DOH’s assertion that the mohel was the most likely source of the infection. His testimony points to infection inadvertently transmitted by his wife, who had recurrent mouth sores before the onset of her baby’s symptoms, and who testified as much to hospital authorities.
HUNTING DOWN THE MOHEL
Unfortunately, the DOH’s blind focus on mbp has diverted attention from the more likely causes–infection by a sibling, parent or other caregiver–and has robbed the public of educational information vital to the proper care of newborns.
In addition, as will be seen below through Mr. R.’s testimony, the DOH’s efforts to lay blame at the doorstep of mohelim has led it to badger and harass the parents of the sick newborns to identify the mohel and to divulge information about the milah.
These intimidation tactics included bringing in CPS (Child Protective Services) to pressure the parents to talk, or face having a case of “child neglect” opened against them.
In the case of Mr. R., frustrated at the parents’ lack of cooperation, the DOH even subpoenaed the couple’s rov, a distinguished Brooklyn rabbinic leader and halachic authority. DOH officials subjected the rov to a hostile interrogation in an effort to extract information about the mohel, the baby’s circumcision and the rov’s colleagues and congregants, who might then be similarly pressured to divulge information.
Although almost seven years have passed since these events, neither Mr. R. or his rov, Rabbi P.* have forgotten the anguish they caused.
In an interview with Yated, Mr. R. said he was galvanized to come forward after reading about a similar case of neonatal herpes described above, in which the infant died. The mother was made a subject of a criminal investigation after refusing to disclose the name of the mohel.
“I couldn’t help but notice how similar our stories are,” Mr. R. told this writer. “You would think in a hospital the main interest would be how to help the baby. But we did not feel this was their main concern. Behind the friendly façade, they were trying to build a case of child neglect against us because we wouldn’t give them the information they wanted about the mohel.”
At the time these events played out, Mrs. R. was running back and forth from the hospital to her family, trying to take care of her children and keep the home running, while coping with the devastating fact that her new baby had brain damage.
“She would me call me crying about how they were hounding her at the hospital and asking what she should do,” Rabbi P. who was present at the Yated interview, recalled. “Until I myself was subpoenaed and questioned in the same manner, I could never have imagined responsible officials would conduct themselves this way.”
SHE BELIEVED SHE HAD UNKNOWINGLY INFECTED HER CHILD
Recalling the traumatic saga of herpes infection that led to brain damage in his infant son, Mr. R. recounted to Yated, in the presence of his lawyer, Mr. Yerachmiel Simins, the events that led up to the baby’s hospitalization first in Maimonides Medical Center and afterwards in Columbia Presbyterian.
He said that at seven weeks old, one week after the baby’s bris which due to jaundice had been delayed, the infant came down with a rash and blisters in the diaper area. Doctors at Maimonides diagnosed herpes and treated the infection.
After two weeks the baby was discharged, only to be rushed to Columbia three weeks later when he was stricken with seizures. The parents learned that the HSV-1 infection had spread internally, causing irreversible brain damage.
Mr. R. recalled being questioned repeatedly at both hospitals about the identity of the mohel and whether mbp was performed. The couple declined to respond.
In response to inquiries about whether anyone in the family had herpes at the time of the baby’s illness, Mr. R. recalled that his wife had told health workers she herself had suffered a bout of mouth sores prior to the baby’s hospitalization.
Had health workers pursued this important clue, they would have learned that Mrs. R. herself believed, after learning how a herpes infection is transmitted, that she herself had unknowingly infected her baby due to her own cold sores.
As she told her lawyer, Mr. Simins, she had a habit of biting her index finger; when applying ointment to the circumcision cut on her baby and changing the gauze dressing, that is the finger she invariably used. She suspected that the germs were carried from her saliva to her baby via her index finger as she was never told to wash her hands before changing the dressing–and never did.
This vital roadmap to the baby’s illness was ignored by the hospital and the DOH in their knee-jerk attempt to link the infant’s infection with the mohel.
BUILDING A CHILD NEGLECT CASE
“My wife got the brunt of the questions because she was in the hospital with the baby most of the time,” Mr. R. recalled. “They would try to get the name of the mohel in all kinds of ways, sometimes by working the question into a friendly conversation, like, “So you made a bris recently? I have a new grandchild whose bris is next week. Which mohel did you use?”
When indirect questioning failed to yield results, frustrated health workers resorted to other methods. Plans were put into place to open a case of child neglect against Mr. and Mrs. R.
A meeting was called with at least ten doctors, nurses and DOH officials to discuss the potential for such an investigation.
“One of the doctors who attended this meeting later shared this information with me,” Mr. R. recalled. “He said the meeting’s purpose was to find a way to pressure us to give the DOH the information they wanted. Another doctor and friend of family, Dr. Allan Werzberger, pointed out to me on the medical chart the signatures of all the people at this meeting He said it might be a good idea to have a copy of his memo but I didn’t follow it up.”
Mysteriously, when the hospital turned over the baby’s medical records to Mr. R. upon his request, the document about the meeting was cut off at the bottom, with the names of the attendees missing.
But evidence of the scheme to concoct a case of medical neglect jumps out from the paper trail left in handwritten notes by Child Advocate Coordinator Dr. Jocelyn Brown, who was called in by the DOH’s Dr. Susan Blank. The notes sum up a meeting with Dr. Blank over the problem of Mrs. R. refusing to crumble under pressure and what to do about it.
“Mom not giving DOH much information about the time and place of the circumcision and who did it,” Dr. Brown’s “Child Protection Consultation” begins. The notes go on to describe a chilling strategy to be used in extracting the information. “We discussed the possibility of reporting [Mr. and Mrs. R.] for medical neglect and lack of cooperation in providing information to the DOH.”
SEE SIDEBAR
CITY’S OFFENSIVE AGAINST MBP GAINS MOMENTUM
The offensive against metzizah b’peh, far from abating, has picked up momentum, as remarks by Mayor Bloomberg last week denouncing the ritual as “putting a child’s life in danger” were played up by the media.
“We will not permit this practice [of mbp] to the extent that we can stop it,” the mayor said.
Bloomberg’s remarks drew fire for being insensitive and disrespectful.
“Orthodox Judaism isn’t barbaric,” said Brooklyn Assemblyman Dov Hikind. “Who cares more about children than their own parents? There’s no call for Mayor Bloomberg to speak disrespectfully to our community, to speak condescendingly about our cultural traditions.”
The rabid offensive against mbp has sounded an alarm in Orthodox Jewish groups who view the city’s stance as irrational and indicative of an agenda that has little to do with a public health issue.
‘INFORMED CONSENT’ PROPOSAL VIOLATES FREEDOM OF RELIGION, SPEECH
A DOH proposal under serious consideration would prohibit mohelim from performing mbp without first cautioning the baby’s parents about the alleged life-threatening dangers. The mohel would be required by law to obtain the parents’ written consent on official government forms.
Prominent Orthodox organizations in America, Canada and Israel have joined forces to vigorously protest the city’s efforts to interfere with the sacred mitzvah of bris milah, and to issue a rebuttal of its unproven medical claims.
In a pair of hard-hitting legal overtures to the DOH by acclaimed legal firms Jones Day and Summer/Young, Orthodox Jewish leaders from Agudath Israel, The Central Rabbinic Congress of the USA and Canada (CRC) and the International Bris Association (IBA) have warned that the city’s proposal to regulate mbp –if adopted–will trigger a fierce court battle over its legality.
The legal letters addressed to the DOH attack the proposed amendment for violating the bedrock constitutional rights to freedom of religion and freedom of speech.
“The proposal is not just bad public policy,” wrote Jones Day attorneys Shay Dvoretzky and Yaakov Roth on behalf of IBA, “it would interject the government into venerable religious ritual that boasts an incredible safety record.” There is no precedent for such government intrusion into Jewish ritual.
The Jones Day memo also blasted the city for seeking to force mohelim to say something they fiercely dispute. That is a direct violation of the right of Freedom of Speech, the brief said.
The law that protects one’s right to speak freely also protects him from being forced to utter something against his will. To compel a mohel to participate in “a misguided effort to spread undue fear about metzitzah b’peh” is clearly illegal, the letter argued.
PROPOSAL SUSPICIOUSLY VAGUE
Attorneys Dean Summer and Jeffrey Baker writing on behalf of the CRC, exposed additional flaws in the proposal about “informed consent,” noting that it contained no model text or specific language that would enable the public to make an informed choice to approve or reject it.
How can the community accept a proposal whose parameters and implementation are unknown at the present time, and will only be decided [by the DOH] at a later stage?
Given the erosion of trust about DOH motives with respect to mbp, and the suspicion that a political agenda is driving the train, why would the Jewish community be receptive to even a benign-sounding proposal about a limited form of government regulation?
ISSUE UNITES ORTHODOX WORLD
The issue has generated unprecedented solidarity among all streams in the Orthodox world, uniting the full spectrum of Chasidic and Litvish communities against any form of government regulation of mbp.
Agudath Israel in a separate letter to the DOH said the proposal, if adopted, would poison Jewish community relations with the DOH, destroying trust and undermining good will.
“It would foster the perception in the community that the DOH is heavy-handed, set on direct confrontation and not interested in working with the community,” the letter said.
It urged the DOH to rethink its approach and to turn to the 2006 protocols adopted by New York State in cooperation with doctors and rabbis representing the Orthodox Jewish community.
STANDING UP TO HYSTERIA
The 2006 protocols called for public education about the risks of nenonatal herpes and the warning signs to be on guard for. It also required specific sanitary procedures formohelim to follow which should eliminate any possible risk of transmitting infection.
The protocols were hammered out six years ago in extensive negations between the NY State Health Department and representatives of the Orthodox Jewish community. Experts believe they have been effective in raising safety standards.
Yet city officials feel the need to depart from the protocols and insist on “informed consent” to curtail mbp. Why? This intransigence and bias has baffled observers and spurred suspicion that a political agenda has overtaken genuine public health concerns.
The CRC in a letter to the Department outlined the “fatal legal flaws” and “flawed medical science” underlying the proposal for “informed consent.” The letter added that “we trust in the Department to stand up to what verges on hysteria and recognize that legitimate public health education can be undertaken to protect infants from HSV-1, without intruding on our religious rites.”
Many see the DOH proposal for informed consent as a dangerous harbinger of further restrictions and regulations to come. Suppose “informed consent” is adopted but fails to limit the practice of mbp? Will the next step be a proposal to ban it entirely, as Mayor Bloomberg has made it clear he would like to do? What next? Targeting bris milah itself?
SIDEBAR
MEDICAL RECORDS TELL A CHILLING STORY
Mr. R. is in possession of his child’s medical records from Columbia and shared their contents with this writer. The record shows that when the time came to discharge the baby from Columbia, the couple was informed that an ACS (Administration for Child Services) coordinator had been called in by the Department of Health to determine if there were grounds to suspect child neglect.
Mr. R. understood this to be a threat. “They let me know my life would be a lot easier if I just gave up the name of the mohel,” he said.
From the handwritten notes by the aforementioned Dr. Jocelyn Brown, the Child Advocate Coordinator in the case, a picture emerges of Dr. Susan Blank attempting to implement the threat by enlisting Dr. Brown in a scheme to report the couple for medical neglect.
Dr. Brown describes the strategy in her notes under “PLAN”:
The plan calls for “DOH to continue to get all the [baby’s] medical records from the outpatient department;” to arrange “a meeting with the DOH and Mr. and Mrs. R. to obtain details about who the mohel was and where the circumcision was done.” And lastly, “to discuss possibility of reporting [for medical neglect] with medical and DOH team.”
The baby’s medical records along with the medical records of the couple’s other three children were in fact requisitioned by the DOH and turned over by the family’s pediatrician. In addition, a psychiatric evaluation was ordered for Mrs. R. to determine if she was a fit parent.
The record shows further that discussion took place about whether to hold up the baby’s discharge while an investigation was underway, and the possibility of placing the baby in a special “therapeutic nursery.” [Read: remove the baby from mother’s care.]
Below are excepts from the Mr. R’s baby’s medical records, in which the groundwork was being laid to launch an investigation into the couple’s incompetence as parents.
Under “Case Management: Social Worker/DOH Issues: Dr. Susan Blank,” it was noted that “Dr. Blank spoke to Mom. Mom not forthcoming with information regarding details of circumcision; date, who performed it; how it was performed, etc.”
The psychiatric evaluation was even more damning. Mrs. R. was described as showing “flat affect” (little or no emotion), and “as not engaging well with infant when examiners in room.”
The report went on to say that the mother “was not forthcoming about information”; that she was “guarded” … and “refused interview” with the psychiatrist. [Which mother, knowing she was at the mercy of “examiners” who were scrutinizing her for negative findings would behave differently?]
The Discharge Summary went on to recommend infant-caregiver therapy (teach mother how to love and care for her baby) and to assign the baby to a “possible therapeutic nursery,” while the discharge was being stalled.
LAST MINUTE CHANGE OF HEART
Fortunately for Mr. and Mrs. R., the Child Advocate Coordinator, Dr. Jocelyn Brown had a change of heart. As she became more involved in the case and better acquainted with Mrs. R, she saw no basis for a claim of medical or child neglect and according to the Discharge Summary, said so. Thus, the disastrous consequences to which a case of medical neglect would have led thankfully did not materialize.
The Discharge Summary notes this sudden turnaround: “After further assessment by the primary medical team” (Mrs. R.’s physicians as opposed to experts called in by the DOH), the recommendation to remove the baby from his mother’s care was found to be “not necessary.” In line with her doctor’s evaluation, Mrs. R. was deemed “capable and with good social support,” as well as “active with her child.”
The baby was discharged but the DOH obstinately refused to drop the case. Two weeks later, Mr. and Mrs. R. were subpoenaed and questioned again by the same Dr. Susan Blank whose plans had been thwarted by Dr. Brown.
Frustrated at their failure to pry information from the parents about the mohel and whether mbp was performed, Blank and Dr. Julie Shillinger then subpoenaed the couple’s rov,Rabbi P. Together with a third woman, Ms. Goldberg-Kahn, counsel for the DOH, the women questioned the rov relentlessly.
For a half hour, Rabbi P. was interrogated about whom he discussed the case with, as if “the case” involved a crime.
Did you discuss it with your colleagues? With congregants? With any members of the Mr. and Mrs. R.’s family? Have you told anyone who performed the baby’s circumcision? Have you discussed the baby having metzitzah b’peh with anyone other than Mr. and Mrs. R.? Has anyone discussed the circumcision with you other than Mr. and Mrs. R.?
Rabbi P., who on the advice of counsel refused to answer many of the questions, described the scenario as “shameful.”
Without a shred of evidence linking the mohel to the baby’s contraction of herpes, he says, “there was no justification for badgering a rabbinic leader totally unconnected to the episode about his private conversations with colleagues and congregants. There was no excuse to harass me about what I may have said to anyone about anything at all. This was an abuse of power.”
“It was strictly for the purpose of intimidation, to insult kovod haTorah on the pretext of protecting the public.”
The greatest irony in all this, Rabbi P. said, “is that there is no government or system anywhere in the world that places a higher value on life than the Torah. But for people hostile to Yiddishkeit, metzitzah b’peh sells well as a way of ridiculing frum Jews and the Torah.”
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19 Responses
It is brought down, that when a Ehrliche Moihl does MbP, his Dmus Dyoiknoi (Tzelem Elokim) gets pinned on the child’s body. So when Yosef revealed himself to his brothers and showed them his Mokom Hamila, they saw the Dmus Dyoiknoi shel Yakov Oveinu. That’s why they believed him and became so frightened.
So we see the Soidois Hatoroh thats behind Niglah.
All the nice people with extra Emunah in our goyishe government – wake up and smell the Golus!
is she allowed to say who the mohel was? and i think someone should start a organization that test and recommends a mohel in your town, city, community,
Why does the DOH do a study of non-jewish babies, circumcised or not who have contracted the herpes virus after birth and died of it. I am sure that in the general population there are an equal amount of cases and it has nothing to do with bris milah. This persecution of injustice is pure rishus.
If what she says in the interview is true, she should publicly come forward and provide the evidence and identify who in the Department of Health intimidated her. Otherwise, her words are useless and have little credibility.
#5
Gadolhadorah
She actually came out and identified the 2 doctors in the DOH, Dr Susan Blank and Dr Julie Schillinger who intimidated her.
Yes, and these are the same doctors who intimidated the other families, where the DOH suspects “neonatal herpes” perhaps caused by MBP.
It is well known in the NYC Dept. of Health, that both of these doctors have an agenda to eliminate the practice of Metzizah, and to regulate Bris Milah.
It is also well known in the NYC Dept of Health, that Dr Blank and Dr Schillinger are in consultation with some Modern Orthodox Rabbis, who are of the opinion that MBP should not be performed.
They are also assisted in their quest by a Modern Orthodox pediatric urologist from North Jersey who made it his goal to eliminate the practice of MBP.
The DOH wants to prohibit mohelim from performing the practice
Wait a minute, I thought they just wanted parental consent. I don’t see why anyone would object to that. Any frum parent who believes in the necessity for MBP would of course consent. Those who hold that it’s not necessary won’t. Sholom al Yisroel.
The issue has generated unprecedented solidarity among all streams in the Orthodox world, uniting the full spectrum of Chasidic and Litvish communities
What about Briskers who don’t hold of it?
Why do I find this article reminiscint of the Postville libel?
SolomanA please post the names of both the Modern orthodox ‘Rabbis’. And the urologist so perhaps they will be given the oppurtunity to be reducated about MBP.
Why doesn’t the frum community get together and help the families hire lawyers to sue the DOH for harrassment (or anything else) that could send it to court where the facts speak for themselves?
To #1
Only Yakov Avienu was the one who did the Metzitza on Yosef, so it would be the Tzelem of Yakov, that was implanted onto Yosef’s body.
I’m troubled by several things in this article. The mother of the child that suffered brain damage states that she thinks that she’s the one that infected the child due to the transfer of her (infected) saliva to the makom hamila via her finger. If saliva is an acknowledged agent for transfering the infection, why does everyone here seem to think that there’s no possible way that the Mohel may have inadvertantly transferred the infection via MbP? His saliva definitely came in contact with the makom hamila – and directly, not via a finger!
I’m not suggesting that MbP be banned – but why the knee-jerk reaction against everyone who suggests that Mohelim be tested for herpes, with those who test positive precluded from performing MbP??? I know that the Mohel who did the Bris on one of my sons specifically asked that _I_ do the Metzitza to avoid exposing my son unnecessarily to any infections. When I protested that I had a cold and didn’t want to expose him to that, this well-known Chasideshe mohel from Boro Park, a relative of whom had done _my_ Bris many years previously, told me that “I’m sure that that cold is much less than all the things I’ve been exposed to”. I therefore did the MbP myself – but had I known then what I know now, I would have had myself tested for herpes first.
So please, let’s stand up for our right to keep our traditions, but let’s not be blind to risks that are staring us in the face.
an Israeli Yid
anIsraeliYid – maybe you should join the DOH too.
The issue is not whether mbp ‘could cause herpes’. Of course, if it was know that the mohel had the disease, AND there was no other likely source, we would have to concede that the odds are that it came from the Mohel.
But the story here is that a) the DOH does not even know who the Mohel was and certainly not that he had a disease, and b) they are purposefully ignoring a more likely source of an immediate family member that had definite symptoms of mouth sores.
That indicates that they have an ‘agenda’ to attack Milah, and are slanting the facts to unfairly raise public support for their cause.
Even if someone personally wouldn’t insist on mbp due to the opinion of their own Rabbonim, it should frighten them that the religious freedom of their fellow Jews are being threatened. It may ‘just’ be mbp this time which they may not mind becoming outlawed, but next year it could be Milah, Shechitah, Chanuka Menorahs, Sereifas Chometz fires, and countless other ‘hazardous’ practices that we ‘endanger public safety’ by doing.
#12
anIsraeliYid
perhaps you are troubled because you did not read the article clearly.
The mother had an “active herpes sore” on her lips. An acute infection.
Whenever there is an active herpes infection, the infection is transmitable and very contagious.
On the other hand, the Mohel does not/did not have any active infection. Therefore it stands to reason that he did not transmit any virus to the baby.
I have observed many Mohels, and spoken to them regarding their practice. None of them, not one Mohel will perform Metzizah B’Peh if they have any type of active infection or sores.
What this article is clearly proving is that the NYC dept of Health is NOT interseted in persuing and finding the true causes of Herpes, rather it blindly alleges that MBP is the cause for every case of neonatal herpes in the Frum Community
What you have not seen or heard about here were news accounts discrediting Debbie Maimon’s first story that appeared in NY Jewish Week.
Maimon’s first story is uoted above with “…In a live interview with Yated earlier this month, however, the mother of the baby who died came forward to set the record straight. Mrs. K. testified that her newborn’s older sibling who had recurrent oral herpes–a fact recorded in hospital records—and had shared his pacifier with the infant, had been the likely source of the infection…”
HOWEVER…according to DOH records the child who died had herpes in the genital area, and not the mouth…totally debunking Maimon’s report.
Stick to the facts.
That story
Bravo Yeshiva World, thank you for fighting Hashem’s fight. Baruch Hashem people are waking up. This is where the geula starts. When people wake up and say Ad Khan! V’yeionchu… V’ta’al Shavosom El Hoelokim. Like then now, the z’chus of
Bris Milah shakes us out of the darkness of galus and brings us closer to our heritage, and shows us the darkness of the goyim, and meshumadim. Keep on the battle fellow Mockabees!
To yitzik and solomonA –
Yes, I did read the article and noted that the mother had an open sore, and that could well be the source of infection in the case at hand. That, however, was not my point – my point was mainly that the article (and other similar articles) all seem to presume that there is no possible way that the Mohel can be the source. Based on the acknowledged fact that saliva was the likely medium of transmission in this case, we clearly agree that contact of saliva with the open wound is a potential method of infection. Based on that fact, I don’t think it unreasonable to ask that the Mohel be tested. By deliberately preventing such testing, we’re burying our collective heads in the sand and possibly exposing other children to the same risk. If we’re so sure that the Mohel isn’t the source, then why not have him tested and PROVE that he’s not the source???
an Israeli Yid
You have a good point. Yes, additional reasonable diligence and caution on the Mohel’s part is appropriate.
But in the case of this article, it is already after the fact. It would be just a strong suggestion to the Mohel (anonymously) to do it privately. It doesn’t have anything to do with the DOH ‘lynch mob’ trying to charge parents as criminals for not telling them who the Mohel was, or trying to ban or restrict MBP unilaterally. It doesn’t justify jumping to the conclusion that the Mohel was definitely responsible.
YonasonW says:
“HOWEVER…according to DOH records the child who died had herpes in the genital area, and not the mouth…totally debunking Maimon’s report.
Stick to the facts.”
Now let me tell you the facts. Being that I am a relative to the family, I know it first hand and also saw it in the Medical records that were obtained from the hospital.
The baby had 3 blisters. NONE of them in the genital area! Only one of them came back as Herpes, it was the one on the toe.
A call by a local newspaper to the DOH was answered by “we will look into it and reply by the end of the week”. The week has long passed,,,
So much for the facts.